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* 1. Name of Employer 

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* 2. GMB Region

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* 3. National Regional Individual Workplace(s) (name & address)

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* 4. Name of GMB Officer

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* 5. Employer contact

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* 6. Are there issues with PPE related to this employer/workplace?

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* 7. Safe systems of work (eg social distancing issues)

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* 8. Hygiene including hand sanitiser and hand washing

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* 9. Staff welfare

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* 10. Who raised this issue initially with GMB?

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* 11. What steps have been taken by GMB to raise this issue with the employer – e.g. grievances, letters, accident book entries, H&S inspection log, etc?

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* 12. What response has the employer made?
Include details of risk assessments, training materials, policies and procedures, physical screens, welfare measures, etc.

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* 13. Have these issues now been resolved? If yes, what was the timescale of action taken in relation to issues raised?

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* 14. What testing for Covid-19 has been available? (including accessibility of any testing)

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* 15. How many employees have tested positive? And what was the employers response to this (self isolation of colleagues, deep cleaning of the workplace, etc)

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* 16. Are there issues in this workplace regarding SSP/sick pay for staff who are off with symptoms/are self-isolating or shielding? What measures has the employer introduced?

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* 17. What measures has the employer taken for specific groups such as BME or disabled workers?

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* 18. If care home – how many residents have had symptoms/tested positive?

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